Dr. Michael Mazzini is with North Suburban Cardiology Associates in Stoneham, Massachusetts. In this interview, we speak with him about his use of the MoMe® Kardia wireless remote patient monitoring system (InfoBionic), a 3-in-1 device that acquires and stores ECG and motion data, and transmits it through the company’s cloud-based system for analysis.
Tell us more about your practice, including the number of physicians, locations, and hospital affiliations. What is your role within the practice?
My practice is North Suburban Cardiology Associates. We have one location — we are just north of Boston in Stoneham, Massachusetts. There are a total of 5 physicians and 1 nurse practitioner; this includes 1 electrophysiologist, 1 interventionalist, and 3 (soon to be 4) general cardiologists. My role is the electrophysiologist. We also cultivate referrals from other local cardiology groups who don’t have EP services. We are launching a dedicated EP program for Hallmark Health in May, and we provide EP services for Winchester Hospital; both of these are busy community hospitals. We are also affiliated with numerous academic centers in the Boston area, including Tufts Medical Center, Lahey Hospital, and Boston University Medical Center. By working closely with our referring centers and affiliations, we are able to provide the full gamut of electrophysiology service, from complex ablations, device implantations, and arrhythmia monitoring.
What sparked your interest about the InfoBionic technology?
Over the years, we’ve used various ambulatory monitoring strategies, the most frequent being Holter monitoring, as well as event monitoring and mobile telemetry. My interest in InfoBionic was sparked after discovering their product and realizing they offered a 3-in-1 solution. Rather than going from a Holter monitoring platform and then referring for an event monitor or mobile telemetry, InfoBionic is able to accomplish this with one device and one user interface, so a physician or practice could switch between those different modalities depending on what they were trying to accomplish or monitor. That made it very easy in terms of making sure we had the same type of monitoring device for all patients. Furthermore, there is a very high-quality and intuitive user interface. Instead of waiting 24-48 hours for a Holter to be returned, if I have a high index of suspicion, I can look at the data at any point. The same goes with event monitoring and mobile telemetry. We also have the opportunity, if we want, to look at full disclosure data rather than just a snapshot. I find it helpful to see an arrhythmia’s onset and offset — and it’s very easy when using this tool.
What are the differences in workflow using InfoBionic vs the services you were using from outside vendors?
One of the concerns that we initially had, especially in our busy, independent practice, was a potential disruption in workflow for our staff. However, it has been very easy to on-board people and has streamlined our workflow quite a bit. For example, if we have a patient who has never had any telemetry monitoring, we can start Holter monitoring, and if the Holter is nondiagnostic, we can transition them to event monitoring or MCT with just the click of a button. This has made things remarkably easy for the physicians and staff. It eliminates making a patient turn in an old unit to check out a different one, or wait a period of time before they get a different unit. It has also helped make and exclude diagnoses in a much more streamlined fashion. With event monitoring and mobile telemetry, if we catch something sooner rather than later, it’s reassuring for patients as well. This means we are also more efficient with these devices in terms of turnaround time and wait times for other patients who might be queued up.
What was your first concern when you were told of how the InfoBionic service functioned in a practice? For example, did you have any issues warming up to the idea of receiving full disclosure data, due to the possibly daunting amount of information?
That was one of my initial concerns, but as an electrophysiologist, I always welcome having more of that data to look at — I find it helpful. However, I think it could be one of the few concerns for a general cardiology practice. They could get overwhelmed with information, although the user interface is extremely intuitive and you can quickly cycle through snapshots of information. The service does a great job of highlighting arrhythmias to your attention, and the additional data is there if you need it. I’ve found it to be very reassuring that the platform was happily picked up by my colleagues — they have been very happy with it as well.
Have you had to hire staff to manage this process?
We didn’t have to hire additional staff — we were able to use existing staff. One to two assistants who were previously registering patients for either event or Holter monitors are now managing this process, and their workflow is virtually unchanged from prior in terms of the initial device hookup.
What does your staff think about the MoMe device and doing patient training?
I think they’ve found it to be very similar to the traditional training and understanding of how the basic Holter systems work. This device is very aesthetically pleasing to look at — it’s very compact. It’s also intuitive for the patients to use — they simply press a button if they need to document a symptom.
What feedback have you gotten from patients?
What I’ve found most helpful is to show patients that they can almost immediately start their monitoring because of the cloud-based server. I’ve also been using this as a tool for feedback. For example, instead of showing patients a text report of their monitor findings, I’m able to log into the user interface and show them what was going on during their symptoms. The patients find this very reassuring and compelling. It has allowed us to engage patients in a very different way.
Are you concerned with owning devices that patients will not return them?
I guess there is always that theoretical possibility, but we haven’t yet seen any issues. We never really saw this issue with our previous Holter units either.
Can you give us an example when having full disclosure ECG data available was helpful?
Yes, I have a couple of patients where we’ve been able to document SVTs, and it’s very great to be able to go back and look at the onset of the termination of the tachycardia. Full disclosure is also helpful when scrolling back and looking at hard data trends, such as when a tachycardia might be “warming up” (abruptly starting or terminating). We have had some very good luck detecting new-onset atrial fibrillation with this monitoring as well. In addition, it's beneficial to be able to go back and scroll through that data to see if there is anything else that was missed.
With InfoBionic, do you think there is a more equitable billing opportunity for the practice?
Yes. InfoBionic has approached the business model a little bit differently than local telemetry vendors in the past. It is a unique monthly subscription as a service or SaaS model, completely different from a fee for service or split billing offered by others. They’ve set up a cloud-based server, which allows the practice to be the originator of the service and perform all the required functions, allowing us to collect both the technical and professional fees for the device, which I think is something that a lot of practices and institutions will find to be a little more equitable.
What else do you find as being beneficial or exciting with InfoBionic?
For me, having the ability to get whatever information you want from the device is total control. You can choose what you want to get notified for, what you want to see, and when you want to see it (rather than waiting for a report to come at the end of 2 weeks or the end of the month). I think that is the biggest game changer. It’s that control over the data that I think is the most compelling.
Is there anything else you’d like to add?
This has really changed our approach for arrhythmia monitoring. It’s a great noninvasive device. The other thing that is exciting is their high level of processing power, which I think will give us an opportunity to improve those algorithms in the future.
Disclosure: The author has no conflicts of interest to report regarding the content herein.